Gyne Returns

[tomorrow]

I haven't posted in a while. Not since after my surgery. My work monitors my interent activity and I rarely use a computer at home. Anyway here's the deal. I had pretty severe gyne considering my build. I'm tall and fairly thin so the man boob thing wasn't really working for me as it might for some of my heavier friends. Through doctor recommendations and letters to my insurance company I was able to get the surgery covered in full. My prayers were answered. Everyone gave me the assurance that my gyne would not return. All my hormone levels were fine, I don't smoke, use drugs, liver is in good shape, etc. Well 6 months later I'm back where I started. Its like my problem never left. It somehow slowly made its way back and now it looks like it did prior to surgery. My surgeon agreed and is going to do another surgery this time just lipo going through a small insertion in the sides of my breasts. Has anyone else gone through surgery and had their gyne problem rerturn? I haven't gained weight. I work out at least an hour a day. How can breast tissue return that fast and why? I had my glands under my nipples removed because I thought that might be the root of the problem. That area is just as inflated as before. Thoughts are greatly appreciated.

[Yoshi]

See an endocrinologist because it may have come back due to a hormonal problem and if your surgeon took it out once and came back, I would put money that it will come back again if its removed again.

[tomorrow]

I saw an endorcronologist before my first surgery. This was after seeing my primary care physician and getting tests. I got every test possible and everything came back fine. I had a bilirubin count that was a little high but that was it. I aked around (including on this board) and no one seemed to think that could have any effect. My homrone levels were right where they should be.
Has anyone here had surgery and had gyne return?

[Time_to_fix_it]

Hi,

Sorry to hear your story, but one thing needs to be made clear.  There is only ONE thing that causes Gynecomastia and that is an imbalance of Androgens (namely Testosterone) to Oestrogens (namely Oestradiol).  There are a number of things that can cause the imbalance but the breast gland only grows because of that imbalance.

IMBALANCE  is the important word here.

It is the imbalance in favour of Oestradiol that causes the breast gland to grow.  It is perfectly possible for a person to have levels of Testosterone and Oestradiol within “normal” limits to have an imbalance.  For instance your testosterone could be low but within “normal” limits and your oestradiol could be high but within “normal” limits.  An Endocrinologist should know this but most work in the more common problem areas of diabetes.  An endocrinologist with a specialisation in reproductive systems is the person to see.  I have found that too many doctors and even endocrinologists just look at the numbers that come out of the blood tests and don’t look at the ratios or balances.  They are often too quick to pronounce someone as normal if the numbers fall within the “normal” range.  There is someone on this site who may be able to help you find an endocrinologist with the necessary experience in your area.  I would suggest you either re-post asking Hypo-is-here to help you or send him a private message.

I take your point about having had surgery and the gland removed, so it raises the question of how can it re-grow?   All of us men start out with a very small amount of breast gland.  If we are unfortunate enough to have an imbalance in the above hormones then that gland grows.  If the surgeon doesn’t remove ALL of the gland, then the remaining amount, small as it may be, can re-grow if that hormonal imbalance remains or returns.

Reading your story it would appear that you have been very unlucky as you did see an endocrinologist before you went ahead with surgery.  It is my guess that he didn’t really have any, or enough, experience in the field of gynecomastia and its causes.

Good luck and please keep us posted.

[Bradley07]

you said that there is only ONE thing that causes gyne and that is a hormonal imbalance. However, from the literature I've read and the doctor's with whom I have spoken, that is simply not true. They state that many times (perhaps even in *most* cases) the gyne has no known cause and that it can occur even when hormonal levels are correct. So I don't believe that hormones are the only thing that causes it.

[Time_to_fix_it]

Hi Bradley07

I take your point about doctors pronouncing that gynecomastia sometimes has “no known cause” (idiopathic).  It is thought that 25% falls under this category.  However it is not the gynecomastia that is idiopathic, it is the hormonal imbalance that is idiopathic.  Gynecomastia is simply a result of a hormonal imbalance.

You also use the phrase .... “that it can occur even when hormonal levels are correct”.  This is exactly what I meant when I said that many inexperienced doctors just look at the numbers that come out of the blood tests.  The levels of testosterone and oestrogen maybe within the “normal” range .. but they are out of balance. And that imbalance causes the gynecomastia.

This isn’t my opinion (I’m not smart enough to figure this out by myself) I have acquired this information by seeing a Professor of Endocrinology and Dr Malcolm Curruthers  (probably one of the worlds foremost experts on the male hormonal system).

The point I am trying to make is that Gynecomastia is caused by a hormonal imbalance.  It is what has caused that imbalance that is relevant.  That is why it is so important to be sure that the underlying cause of that imbalance has gone or been treated before having surgery.

TOMORROW, who started this post, did all the right things before having surgery.  The fact that his gyne has started to grow back leads me to believe that he was unlucky in not having an Endo with the necessary knowledge or experience.

[tomorrow]

Well the Endo I saw has diagnosed cases before. He even helped me get insurance to pay for it but couldn't say it was a hormone imbalance due to my test results. I went to him for extensive tests after my primary care physician did tests that came back fine. My Doc treats a few trannies (I learned this when asking him about testosterone suppliments) so he knows a thing or two about sex hormone balance. My gut instinct tells me its not hormone imbalance. My gyne started around age 21. I don't show any other signs of low testosterone. I mean I have back hair which I'm not proud of.
Thanks for your replies. Keep them coming. I'm hoping to hear from someone who might have had this problem return after surgery. Next week I go in for surgery #2 but this time I'm awake and he goes in through the sides instead of under the nipple.

[Paa_Paw]

Yours is a very important post in many ways.

It is always possible for the breasts to enlarge again. This enlargement could be either glandular, fatty tissue, or both; as with the first growth.

Seeing an Endocrinologist is (was) your best assurance that the  condition would not return, and you did that. Even so, the breasts did enlarge a second time.

The simple fact is that the human body does things that we do not always understand. Your case clearly illustrates why there are no guarantees with cosmetic surgery.

I get the impression that your surgeon has agreed to a revision, Hopefully with more lasting results.

While your situation is not the rule, neither is it all that rare. and it is one possibility that anyone contemplating surgery should be aware is possible.

[headheldhigh01]

all that is probably true, although as hypo might observe, the issue is not restricted to whether levels are in certain ranges but also ratios, and we don't know for sure whether the endo in this case looked at that.  would be interesting to know.  

[babble]

Tommorow,
I am in the same situation as you.   I had surgery, 6 months later I was back to my old self, and it's gland.

My Blood word came back 'within normal ranges'.  My endicronologist is doing more tests now, I'm waiting on the results.  I have more body hair than I know what to do with, but I also notice other femine features, like the way my body stores fat, alot on the chest, and hips (hips seem to be wider than most males).  I'm waiting results for klinefelters (unlikely given my physical attributes).

He seems to think everything is fine, and that my re-growth could be attributed to beer.  I find this hard to beleive.  I dont' drink any more than my friends, and they aren't growing boobs.    


My Estradiol level is 168  pmol/L.  From my research that's on the higher scale of normal.   Becuase it falls within a 'range', my endo has dimssed it so far.  Seems to me like this is the cause, but I, like you, am kinda stuck.  I don't have my pick of endo's, it's canada, you get referred.

Does anyone know what we can do about this imbalance?  What can cause it?  How do we address this issue without proper care from our endo's?

[infinity123]

Very interesting. I too had surgery about 6 months ago, and I think my gyn is coming back. Like the two guys above, I went to an endocrinologist before surgery. My results were pretty much normal. Testosterone was a bit low but in the normal range, estradiol was also in the normal range. We didn't discuss the ratio of the two.

I'm in my late 30s, and my gyn appeared when I was about 17. I haven't done drugs or steroids etc, so my case was considered idiopathic. Like the second guy above, I probably drink a bit too much, but certainly not more than my other single friends. All things considered, my surgeon thought it was extremely unlikely that I would have a recurrence. I was very flat after surgery. So this is really horrible.

One question I have is whether anyone knows if there is an accepted ratio of estradiol/testosterone that is considered abnormal? I'm going to make an appointment this week with another endocrinologist and try to answer some of these questions.

To the guys who are having recurrences: How did the results look immediately after surgery? Why do you and your surgeons think that a second surgery will somehow prevent more recurrences? "Tomorrow", what will your surgeon do differently during the second surgery? It seems like having surgery without also doing something "hormonal" (such as testosterone supplements) would be putting yourself through a lot if it seems likely that the gyn would return.

At what point did the gyn begin to recur, or become most noticeable? Do you have any idea if it is more fat or gland that has returned?

[merle]

I will say it again, that the only study I have seen on the topic says that it come back in 30% of first surgeries and 20% of second surgeries.

It is about hormone balance but you have to remember that it is also genetics. Some guys can take steriods and have no problems. Others walk by the creatine and develope gynecomastia.

We are all working with a different deck of genes and they all play out differently.

If it is coming back, I would be looking at diet, suppliements, medications, etc.

Merle

[merle]

One more point, is the endo checking liver function?

Merle

[cuz]

Mine has come back several times.  I've had 4 surgeries.  Glandular only, no lipo.  I do take steroids but stay clean well before, during, and after surgery.  Both plastic surgeons were aware of this.  

What's weird is that 10 years ago I had my first surgery and the gyno (hard lumps, no fat) came back in about 1.5 to 2 wks.  Doc performed 2nd surgery and it only came back in the left nip, again about 2 wks post op.  Thats the weird part.  Why only 1 nip.  Had 3rd surgery, left nip, on May 23, 2006.  I told doc to remove entire gland.  It came back again same thing, about 2 wks post op.  Just had 4th surgery Sept. 18.  Doc said there was some gland and he thought he got it all in the last surgery.  As I sit here now, 9 days post op, I feel a large lump forming.  I don't know what else to do.  I have asked on this board and bodybuilding boards and no one has any answers.

By the way, my nips always have looked fine the 1st week post op except for a little swelling.  Scars even heal fine.  

HELP

[cuz]

One more thing.  Doc says most of the lump is scar tissue.